On September 12, the Centers for Medicaid and Medicare Services (CMS) released the in-person assistance awards for the 2018-2019 enrollment season. The Administration allotted $10 million to the 34 federally facilitated marketplaces (FFM), a more than 80 percent drop in funding over two years. These cuts have affected each state differently, ranging from 0-100 percent, with very few states receiving an increase in funding.
Fewer Navigators, Fewer States, Bigger Risks for Consumers
Last year, steep cuts in funding led navigators across the country to downsize or even shut their doors completely. Before cuts were announced this year, the Trump Administration changed the rules, removing the requirement for each state to have at least two navigators with a physical presence in the state. Cuts this year translated to less than half of the 90 funded awards last year, with most states only retaining one entity for the entire state. The combined effect of the changed rules and further cuts are likely to make it even harder for remaining navigators to keep their doors open. Last year, there were 90 navigator groups serving the 34 FFM states, whereas only 39 navigator groups received funding this year, seven of which are new groups. Three states, Iowa, New Hampshire, and Montana, had no applicants for this year’s funds and as a result, will have no Navigators providing impartial, in-person assistance to consumers.
Navigators are Unnecessary – Says Who?
CMS argued in their funding announcement for this award that Navigators “failed to enroll a meaningful amount of people” over the last enrollment period. As I have previously written in this space, this argument fails to recognize the work that goes into enrolling consumers in coverage and evaluating their eligibility for financial assistance through the marketplace or Medicaid. Further, the Urban Institute found that more than half of all marketplace enrollees needed consumer assistance last year, and the percentage of consumers going to navigators or other in-person assisters actually rose. Compounding the problem, brokers are increasingly reluctant to serve the individual market due to the time commitment and a reduction in commissions from insurers. With less and less funding going to fewer and fewer navigators, CMS is all but setting up these organizations for failure because they will not be able to enroll a “meaningful amount” of consumers with fewer resources, and won’t have the capacity to take on added consumers as brokers stop serving the individual market.
For example, I volunteer as a certified application counselor in Northern Virginia. Up to this point, there have been two navigators at this organization and, fortunately, several volunteers willing to donate a significant amount of time. In 2017, I worked from 6:00pm to 9:00pm on most weeknights, and on weekends from 9:00am until 4:00pm, with back-to-back appointments. Because we had a consistent group of volunteers to add to the navigators, we were able to help dozens of people on most days, even though appointments average 90 minutes each. In other states, there might be two navigators for an entire state and no active volunteer base. Without resources to maintain navigators and recruit and train volunteers that help consumers who come to the door and reach those who might not yet know about their coverage options, navigators are between a rock and a hard place in trying to meet the vague quantitative goals of “meaningful” enrollment.
Cuts Come at a Time When Coverage Options are Getting More Complicated
Funding cuts to free, impartial enrollment assistance come at a time where several policy changes are taking effect, expanding the availability of alternative coverage options that don’t have to cover pre-existing conditions and many services like mental health, maternity care, and prescription drugs. Further, the Trump Administration is increasingly relying on “direct enrollment,” which allows consumers to apply and enroll in marketplace plans on web-based broker websites that might also sell skimpier, non-ACA compliant coverage. Many of these skimpy plans use marketing language that encourages consumers to believe they are the same as an ACA-compliant plan. Additionally, health insurance scams are now the top source of illegal phone calls to consumers (prior to release of the Trump administration’s short-term plan rule, such calls didn’t even crack the top ten). With limited personal assistance from Navigators or brokers, consumers are at increased risk of enrolling in skimpy plans or insurance scams without realizing that they could be on the hook for sky-high medical bills.
Many navigator organizations have been working with consumers for 6 years now. They have shown themselves to be creative in their efforts to maximize efficiency and get as many people covered as possible. Last year, in spite of funding cuts, navigators had a successful season thanks to a lot of hard work, volunteers, and donations. Let’s hope they end this season just as successful as the last.